Dietary pesticide exposure and non-communicable diseases and mortality: a systematic review of prospective studies among adults.

BACKGROUND: Research on the effect of pesticide exposure on health has been largely focused on occupational settings. Few reviews have synthesized the associations between dietary pesticide exposure and health outcomes in non-occupationally exposed adults. OBJECTIVE: We aim to summarize the evidence regarding dietary pesticide exposure and non-communicable diseases (NCD) in adults, using a systematic review of prospective studies. METHODS: Electronic and manual searches were performed until July 2023. The inclusion criteria were the following: 1) adults aged ≥ 18years, 2) (non)-randomized trials, prospective cohort studies, 3) dietary exposure to pesticides. A bias analysis was carried out using the Nutrition Evidence Systematic Review guidelines based on the Cochrane ROBINS-I. RESULTS: A total of 52 studies were retrieved and 6 studies that met the above criteria were included. Studies were conducted either in France or in the United States. The studies investigated the risk of cancer (n = 3), diabetes (n = 1), cardiovascular diseases (n = 1), and mortality (n = 1). The quality of the studies varied with overall grades derived from the bias analysis ranging from low to moderate bias. The level of evidence was estimated as low for the risk of cancer while the grading was not assignable for other outcomes, as only one study per outcome was available. CONCLUSIONS: Although further research is warranted to examine more in depth the relationships between low-dose chronic exposure to pesticides through diet and NCD outcomes in non-occupationally-exposed adults, studies suggest a possible role of exposure to dietary pesticide on health. Standardized methodological guidelines should also be proposed to allow for comparison across studies.

Association between dietary pesticide exposure profiles and body weight change in French adults: Results from the NutriNet-Santé cohort.

BACKGROUND: Pesticides cause a wide range of deleterious health effects, including metabolic disorders. Little is known about the effects of dietary pesticide exposure on body weight (BW) change in the general population. We aimed to investigate the role of dietary pesticide exposure in BW change among NutriNet-Santé participants, focusing on potential sexual dimorphism. METHODS: Participants completed a Food Frequency Questionnaire (2014), assessing conventional and organic food consumption. Dietary exposure from plant foods of 25 commonly used pesticides was estimated using a residue database, accounting for agricultural practices (conventional and organic). Exposure profiles based on dietary patterns were computed using Non-negative Matrix Factorization (NMF). Mixed models were used to estimate the associations between BW change and exposure to pesticide mixtures, overall and after stratification by sex and menopausal status. RESULTS: The final sample included 32,062 participants (8,211 men, 10,637 premenopausal, and 13,214 postmenopausal women). The median (IQR) follow-up was 7.0 (4.4; 8.0) years. Four pesticides profiles were inferred. Overall, men and postmenopausal women lost BW during follow-up, whereas premenopausal women gained BW. Higher exposure to NMF3, reflecting a lower exposure to synthetic pesticides, was associated with a lower BW gain, especially in premenopausal women (ß(95 %CI) = -0.04 (-0.07; 0) kg/year, p = 0.04). Higher exposure to NMF2, highly positively correlated with a mixture of synthetic pesticides (azoxystrobin, boscalid, chlorpropham, cyprodinil, difenoconazole, fenhexamid, iprodione, tebuconazole, and lamda-cyhalothrin), was associated with a higher BW loss in men (ß(95 %CI) = -0.05 (-0.08; -0.03) kg/year, p < 0.0001). No associations were observed for NMF1 and 4. CONCLUSIONS: This study suggests a role of pesticide exposure, inferred from dietary patterns, on BW change, with sexually dimorphic actions, including a potential role of a lower exposure to synthetic pesticides on BW change in women. In men, exposure to a specific pesticide mixture was associated with higher BW loss. The underlying mechanisms need further elucidation.

Alignment between greenhouse gas emissions reduction and adherence the EAT-Lancet diet: A modeling study based on the NutriNet-Santé cohort.

The potential of the EAT-Lancet reference diet, which promotes a healthy diet within planetary limits, to reduce greenhouse gas emissions (GHGe) remains understudied. This study examines the role of nutritional and acceptability constraints in reducing GHGe through diet optimization, and tests the alignment between GHGe reduction and the EAT-Lancet score. The study used data from 29,413 NutriNet-Santé participants to model French diets and evaluate their environmental, nutritional, economic, and health impact. The Organic Food Frequency Questionnaire was used to assess organic and conventional food consumed, and the Dialecte database was used to estimate the diet environmental impacts. Quality of diets were also evaluated based using the PNNS-GS2 (Programme National Nutrition-Santé 2 guidelines score). When testing minimizing GHGe under strict nutritional and acceptability constraints, it was possible to reduce GHGe up to 67 % (from 4.34 in the observed diet to GHGe = 1.45 kgeqCO2/d) while improving the EAT score by 103 % with 91 % of the food as organic. Greater reductions required relaxation of some constraints. When testing maximizing EAT score under gradual reduction in GHGe, the adherence to the EAT-Lancet diet was not significantly affected by the gradual reduction in GHGe. To maximize EAT score with 75 % reduction in GHGe (1.09 kgeqCO2/d), less strict constraints on the bioavailability of iron and zinc are necessary. The EAT score improved by 141 %, while land occupation decreased by 57 %, compared to the observed value. The diet contained 94 % of organic foods. There was some alignment between the degree of adherence to the EAT-Lancet diet and the reduction in GHGe, but other diets may also lead to a strong reduction in GHGe. Thus, GHGe can be greatly reduced by dietary choices, but require profound reshaping of diets which must be coupled with changes in other areas of the food chain.

Food biodiversity and gastrointestinal cancer risk in nine European countries: Analysis within a prospective cohort study.

BACKGROUND: Food biodiversity in human diets has potential co-benefits for both public health and sustainable food systems. However, current evidence on the potential relationship between food biodiversity and cancer risk, and particularly gastrointestinal cancers typically related to diet, remains limited. This study evaluated how dietary species richness (DSR) was associated with gastrointestinal cancer risk in a pan-European population. METHODS: Associations between DSR and subsequent gastrointestinal cancer risk were examined among 450,111 adults enrolled in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC, initiated in 1992), free of cancer at baseline. Usual dietary intakes were assessed at recruitment with country-specific dietary questionnaires. DSR of an individual's yearly diet was calculated based on the absolute number of unique biological species in each food and drink item. Associations between DSR and cancer risk were assessed by multivariable Cox proportional hazards regression models. FINDINGS: During a median follow-up time of 14.1 years (SD=3.9), 10,705 participants were diagnosed with gastrointestinal cancer. Hazard ratios (HRs) and 95 % confidence intervals (CIs) comparing overall gastrointestinal cancer risk in the highest versus lowest quintiles of DSR indicated inverse associations in multivariable-adjusted models [HR (95 % CI): 0.77 (0.69-0.87); P-value < 0·0001] (Table 2). Specifically, inverse associations were observed between DSR and oesophageal squamous cell carcinoma, proximal colon, colorectal, and liver cancer risk (p-trend<0.05 for all cancer types). INTERPRETATION: Greater food biodiversity in the diet may lower the risk of certain gastrointestinal cancers. Further research is needed to replicate these novel findings and to understand potential mechanisms.

Residential exposure to natural background radiation at birth and risk of childhood acute leukemia in France, 1990-2009.

BACKGROUND: The role of natural background radiation (NBR) in childhood acute leukemia (AL) remains unclear. Several large record based studies have recently reported heterogeneous results. Differences in exposure assessment timing may explain this heterogeneity. OBJECTIVES: In a previous ecological study we did not observe any association between childhood AL incidence in France and NBR exposure at the time of diagnosis. With the same methodology, the present study focused on NBR exposure at the time of birth. Based on data from the French national registry of childhood cancer, we analyzed all AL together, and lymphoblastic and myeloid AL, separately. METHODS: We included 6,059 childhood AL cases born and diagnosed in mainland France between 1990 and 2009. NBR levels in municipalities of residence at birth were estimated by cokriging models, using NBR measurements and precise geological data. The incidence rate ratio (IRR) per unit variation of exposure was estimated with Poisson regression models, with adjustment for socio-demographic indicators and ultraviolet radiation levels. NBR exposures were considered at the time of birth, and cumulatively from birth to diagnosis. We also estimated a total NBR dose to red-bone marrow (RBM). RESULTS: There was no evidence for an association between NBR exposure at birth and childhood AL incidence, neither overall (gamma radiation: IRR = 0.99 (0.94,1.05) per 50 nSv/h; radon: IRR = 0.97 (0.91,1.03) per 100 Bq/m3) nor for the main AL types. The conclusions were similar with the cumulative exposures, and the total RBM dose. CONCLUSIONS: The study was based on high quality incidence data, large numbers of AL cases, and validated models of NBR exposure assessment. In all, the results further support the hypothesis that NBR are not associated to childhood AL in France.

Ecological association between residential natural background radiation exposure and the incidence rate of childhood central nervous system tumors in France, 2000-2012.

BACKGROUND: High-dose ionizing radiation is an established risk factor for childhood central nervous system tumors (CNST) but the role of low doses remains debated. In particular, there are few studies of natural background radiation (NBR, gamma radiation and radon) and childhood CNST, and their results are inconclusive. OBJECTIVES: This study aimed to investigate the ecological association between NBR exposure and childhood CNST incidence in France, considering childhood CNST overall and by subgroups. METHODS: Incidence data were provided by the French national registry of childhood cancers, which has high completeness. We included 5471 childhood CNST cases registered over the period 2000-2012, and their municipality of residence at diagnosis was recorded. Municipality NBR exposures were estimated by cokriging models, using NBR measurements and additional geographic data. The incidence rate ratio (IRR) per unit variation of exposure was estimated with Poisson regression models. NBR exposures were considered at the time of diagnosis, and cumulatively from birth to diagnosis. In an exploratory analysis, the total brain dose due to NBR was used. RESULTS: Overall, there was no association between NBR exposure and childhood CNST incidence (IRR = 1.03 (0.98,1.09) per 50 nSv/h for gamma radiation, and IRR = 1.02 (0,96,1.07) per 100 Bq/m3 for radon). An association was suggested between pilocytic astrocytomas and gamma radiation (IRR = 1.12 (1.00,1.24) per 50 nSv/h) but not with radon (IRR = 1.07 (0.95,1.20) per 100 Bq/m3). Upward trends for this CNST subtype were also suggested with the cumulative exposures to gamma radiation and the total brain dose. NBR exposure was not associated with other CNST subgroups (ependymomas, embryonal tumors, and gliomas other than pilocytic astrocytomas). Adjustment for socio-demographic factors did not change the findings. CONCLUSIONS: Our study was based on high quality incidence data, large numbers of CNST cases, and validated models of NBR exposure assessment. Results suggest an association between gamma radiation, as a component of NBR, and pilocytic astrocytomas incidence in France.